Combination chemotherapy with or without radiotherapy is the treatment of choice in small cell lung cancer. Thus, most studies, both randomized trials and descriptive ones, evaluated chemotherapy and its effects on quality of life (Table 3). In reviewing quality of life studies in patients with small cell lung cancer, the following results could be identified. Diastolic Filling
In a study of 321 patients with small cell lung cancer (of those, 195 patients were entered into the quality of life study), quality of life was found to be dependent on tumor stage and tumor response. Using the Sickness Impact Profile (SIP) in measuring quality of life in 62 patients, Bergman et al found that tumor response correlated with SIP summary scores and anxiety. The same authors with the same patients using the EORTC QLQ-C36 reported that there was good correlation between changes of the QLQ-C36 scores over a given time period and clinical variables as measured by tumor response and performance status.
These findings, however, indicate that early detection of lung cancer is an important issue. Detection of disease at an early stage would allow better management and thus increase the chance of cure. Benefit achievable by screening is limited Early detection mainly depends on referrals by general practitioners. Figures from the Yorkshire Cancer Registry (England) 1988 to 1991 showed that the median delay was 12 days (range, 6 to 20 days) between referral and first hospital visit and 22 days (range, 11 to 40 days) between this hospital visit and the start of treatment.
Intensive vs Less Intensive Therapy
The challenge to improve survival and quality of life led some investigators to study different ways of managing small cell lung cancer. Most studies have shown that conventional (scheduled, planned) policies, although intensive, are providing a better quality of life (less nausea and pain, better sleep, mood, and general well-being) than less intensive (experimental, as required, unplanned) regimens. Comparing standard chemotherapy with a palliative regimen, Wolf et al studied 221 patients and found no significant difference in survival between these two regimens. However, patients receiving the standard regimen had a better tumor response and improvement of quality of life than patients receiving palliative treatment, but the former group had more severe side effects.
Table 3—Summary of Selected Quality of Life Studies in Patients With Small Cell Lung Cancer
|Study (yr)||Design||Treatment||Sample||Quality of Life Measure||Results/Conclusions|
|Bernhard et al||Randomized||Two combination CT||279||EORTC QLQ (41 items)||Physical functioning, treatment side effects, disease-related symptoms, psychological distress, fatigue, and malaise are most relevant aspects of QL|
|Geddes et al||Randomized||CT (scheduled vs as required)||220||DDC||A better QL (less nausea and pain, better sleep, mood and general well-being) in scheduled CT|
|Bleehen et al||Randomized||CT (12 vs 6 courses), RT in limited disease||497||(a) Pts: DDC (b)Phyns: overall condition, physical activity, dyspnea||No significant difference in survival; both assessments showed a better QL in favor of 6-course CT regimen; mood similar in both groups|
|Fayers et al||Randomized||CT+RT (maintenance vs no maintenance)||369||(a) Pts: DDC, adverse reaction to treatment (b) Phyns: overall condition, activity||No significant difference in survival; worse mood and better overall condition in no maintenance group, while those in maintenance group showed more severe adverse effects of chemotherapy; anxiety similar in both groups|
|Earl et al||Randomized||CT (planned vs as required)||300||DDC||No significant difference in survival; more severe symptoms in as required group and less palliative effect seen|
|Wolf et al||Randomized||CT (continuous vs alternating)||321||EORTC QLQ-C36||No significant difference in survival; continuous CT slightly superior; QL depended on tumor stage and tumor response; overall, improvement in QL|
|Hurny et al||Randomized||CT (early vs late alternation)||415||EORTC QLQ-C30, QLQ-LC13||Fatigue and malaise found to be as a global indicator of QL|
|Flechtner et al||Randomized||(a) CT (alternating vs response dependent); (b) (carbo- vs cis-platinum), (c) (treatment for extensive vs limited disease)||600||EORTC quality of life questionnaire||No significant difference between treatment arms in trial (a), but in trail (b) and (c) different; intensive treatment more than 4 cycles results in overall marked negative effect on pts’ QL|
|Cull et al||Descriptive(retrospective)||PCI||64||HADS, RSCL||Anxiety and depression lower than pts recently receiving active treatment; high proportion of pts still experiencing treatment-related symptoms, but not functional impairment|
|Gower et al||Randomized||CT (intensive vs conventional)||75||DDC, ECOG||No significant difference in survival; better QL in favor of conventional CT|
|Joss et al||Randomized||CT (early vs late alternating), RT (in those with remission)||406||Study specific (derived from EORTC 42-item QLQ)||No significant difference in survival; better QL in pts receiving early alternating CT|